Recovery: Severe COVID-19 steroid effect persists

The most ill patients hospitalized with COVID-19 given the low-cost steroid dexamethasone had a significantly lower incidence of deaths compared to those receiving conventional treatment, a UK-based RECOVERY Preliminary results for the test were found.

Patients in the dexamethasone group who received mechanical ventilation were those who received normal care (29.3% vs 41.4%, RR 0.64, 95% CI 0.51-0.81) and those who received oxygen supplementation without mechanical ventilation ( 23.3% vs. 26.2%, RR 0.82, 95% CI 0.72-0.94) reported Dr. Martin Randley of Oxford University on behalf of the RECOVERY Collaborative Group and colleagues.

However, the Landray group did not differ significantly in mortality among groups of patients who did not receive respiratory support (17.8% vs 14.4%, RR 1.19, 95% CI 0.91-1.55). New England Medical Journal..

These are not new results and are based in the UK Randomized assessment of COVID-19 therapy (recovery) Investigator releasing Top line of intermediate results by press release Returning on June 16, investigators said they would submit their data for peer review.

Commenting on June’s top-line results at a press conference at the International AIDS Association’s COVID-19 conference last week, director of the National Institute of Allergy and Infectious Diseases (NIAID) Anthony Fouch (MD) said to ventilator individuals: Characterized the top line results to be “pretty impressive”. I need oxygen.

“It’s very important. It really wants to block the virus, mainly in the early stages, as it exactly matches what we know about the mechanism of the pathogen, but leave the immune system intact. And then if there is abnormal inflammation, I want to weaken it.”

Fauci says dexamethasone is currently on the basis of top-line results NIH clinical guidelines A group of COVID-19 patients who meet the specific criteria used in the study because of “decreased mortality.”

“In many respects, it is now becoming the standard of care for advanced patients who are on a ventilator and/or who need oxygen,” he added.

Also written by Fauci Incidental NEJM editorial He also wrote with NIAID H. Clifford Lane, MD, that a new discovery about dexamethasone “can shed light on controversial therapeutic areas and perhaps save many lives.”

Landray et al. investigated data from patients admitted to COVID-19 at 176 National Health Service organizations across the United Kingdom. Patients were eligible if they confirmed or suspected a COVID-19 infection. Originally limited to patients over 18 years of age, the age limit was removed on 9 May, targeting pregnant and lactating women. The primary outcome was all-cause mortality within 28 days of randomization.

Overall, 2,104 patients were randomized to receive intravenous dexamethasone (6 mg daily) and 4,321 received regular treatment. They had an average age of about 66 years and 36% were women or girls. Over half had at least one chronic comorbidity, 27% had heart disease, 24% had diabetes, and 21% had chronic lung disease.

At randomization, 16% received mechanical ventilation, 60% received oxygen only, and 24% received neither.

Almost all patients in the dexamethasone group received at least one dose, with a median treatment duration of 7 days. However, 8% of the usual care groups received dexamethasone as part of their care. About a quarter of the patients in each group received azithromycin during the follow-up period.

In addition to the benefit of ill patients, Landray et al. found that there was a clear benefit to patients treated for more than 7 days after the onset of the “highly likely inflammatory lung injury” condition. I pointed out.

In the dexamethasone group, the median length of hospital stay was shorter than that of usual care (12 days vs. 13 days), there was a high probability of survival and discharge at 28 days, and randomized mechanical ventilation was used. The greatest impact was seen in patients.

Lane and Fauci demonstrate that this work can carry out a “rigorous clinical study” during a pandemic, similar to a large randomized trial conducted during the 2019 Ebola outbreak in the Democratic Republic of the Congo. I said. Discovered PALM studies Two effective treatments for Ebola According to the editor, it is a far more definitive method than a small study of early Ebola outbreaks in West Africa.

“It is our responsibility in the global medical research community to quickly design, conduct, and complete research into the most promising therapeutics and vaccines for this disease,” Lane and Foech wrote.